Thursday, 27 October 2011

Liverpool Care Pathway – A Dialogue Of Correspondence

A Dialogue Of Correspondence

We were advised by both the Parliamentary and Health Service Ombudsman Service and the Healthcare Commission that they are unable to achieve disciplinary action against individual members of staff. They recommended that we take our complaint to the NMC if we wished to pursue that outcome.

The NMC had this case for over a year during which time the Trust withheld documents for nearly three months, dragging their feet while they were sanitised, perhaps.

Here:

Dear Leslie,

My attempts to have this in a position to pass on have been somewhat thwarted by NHS Surrey's delays in getting the required documentation together.

I wrote to them in February, initially requesting a response by 1 March, although I have been asked for three further extensions to this, which I have granted. Their final extension was w/c 29 March, so I hope that as I have accommodated their requests, they will abide by this date and send in the documentation this week.

I last spoke to them at the end of March, and they stated they had a problem copying the documentation, although I expected a response by now. I shall contact our legal team unless the information requested is not sent through by Monday.

We first wrote to the NMC on 12th November 2009. They eventually wrote back on 12th January 2010. The Case Officer, Mr. Bhuwanee, first contacted us on 26th January 2010.

Mr Bhuwanee spent some time trying to get all the papers he needed from the Trust and actually confided in one email that, if they did not respond, he would contact their legal team.

Mr. Bhuwanee contacted us by email on 11th May 2010 to inform us that we should hear from the investigating committee in 2 to 3 weeks.

Mr. Bhuwanee then observed ‘radio silence’ for a period. A succession of emails and letters received no response.

Dear Sir/Madam,

RE: Mrs Grace Doe

We first wrote to you on 12th November 2009. You eventually wrote back on 12th January 2010. Mr Bhuwanee’s first contact with us was on 26th January 2010.

Mr Bhuwanee spent some time trying to get all the papers he needed from the Trust and actually confided in one email that, if they did not respond, he would have to consult your solicitors.

Mr Bhuwanee contacted us by email on 11th May 2010 to inform us that we should hear from the investigating committee in 2 to 3 weeks. We have since learned, via a telephone conversation with your office, that Mr Bhuwanee has left. As at this date, the 23rd July 2010, we have heard nothing at all from the Investigating Committee.

We visit my mother's grave throughout the year, but yesterday, the 22nd July, was three years to the day this dear lady was taken from us. The whole family went to pay our respects, to celebrate her life and to mourn her death at the hands of staff at Caterham Dene.

There is much explaining to do. This lady was sharp and attentive, as the two Specialist Nurses, Heidi (and her daughter, present on work experience) and Diane, will testify. In Caterham Dene, they took her off all ongoing medication, broke her hearing aid and reduced her to a condition of utter senselessness. She was stuffed so full of morphine that she couldn't talk or think and died of heart failure.

I must clarify that my mother did not leave this world at Caterham Dene. They waited until the point was reached that death was inevitable and only then decided to telephone Thamesdoc before phoning for an ambulance one hour later. At least, whatever may be in the written record, an hour elapsed between the two telephone calls they made to me and I actually arrived at ESH a&e before the ambulance, and was present when they brought her in already dead.

The nurses at Caterham Dene had been permitted to administer the prescribed dose of morphine as they thought fit. The Trust had to require Caterham Dene, on the Commission's recommendation, to change this lax state of affairs. Whatever may be in the written record as to what was administered, that should be looked at in the context of the Commission's report as regards errors in the written record.

This should also be looked at in the context of what the Sister asked us upon our arrival at Caterham Dene. Do we, in the event of anything happening - not that it would - want them to move her to ESH? What a peculiar question to ask. It makes no sense except in the context of a policy being set in place at Caterham Dene to let them go and actually help them on their way!

Can we be informed, please, how this matter is proceeding?

Yours sincerely,

We then learned, via a telephone conversation with the NMC office, that Mr Bhuwaneehad left. As at the 23rd July 2010, we had heard nothing at all from the Investigating Committee.

The replacement Case Officer, Mr. Tilling, maintained that there were only three named registrants and that the NMC may proceed against only named registrants. However, these three registrants were not those at Caterham Dene; they were from the District Nurses Office. In their dalliance and feet-dragging, had the Trust 'sanitised' the record of all other names?

Mr. Tilling had been consulting with his managers upon precisely this matter. He stated:

I have had a discussion about this case with my manager, and it appears that no other nurses can be idenitfied except for the three in the subject heading. The Triage team, with whom you were in previous contact, opened the file in this way for this reason.

Mr. Tilling then observed ‘radio silence’ for a period. Our persistence produced a response, eventually, from his manager, Mr. Brindley.

Mr. Brindley informed us with much aplomb that Amirius Tilling had now left the NMC, as though we were seeking some scapegoat to satisfy our complaint and that he had found one. What is more, quite the magician, he pulled a further 12 NMC PINs out of the hat and presented them to us in the manner of a magician’s parlour trick! He did not supply us with the detail but only the knowledge, so we had no information of their identities, but where had they sprung from if Mr. Tilling had claimed that no other nurses could be identified…?

When Mr. Tilling had made this claim, did he mean there were no other nurses who could be identified or that those additionally identified were not considered as relating to the case? Was this the problem that Mr. Tilling had and was that why he was consulting with his managers?Had Mr. Tilling been wronged? Was he owed a most profound apology? Was he being honest in the face of what was plainly institutional DIS-honesty?

Mr. Brindley said, with much aplomb, Amirius Tilling had now left the NMC - as though we were seeking some scapegoat and that he had found one. First, Mr. Bhuwanee, then Mr. Tilling, - but did they jump or were they pushed? Was the NMC simply playing out a ruse to hoodwink us that all was proceeding well? It is almost as if the NMC exists not to root out the bad crop but, rather, to bury the rotten apples at the bottom of the barrel.

Our experience of this interminable maze of a complaints process is that there is a system in place that sets out to cover the tracks of the wrongdoer at every twist and turn. It is no wonder to us at all that there are people like Shipman who can, quite literally, get away with murder.

So, what was all this time-wasting for? There had to be a reason. It could not be, surely, that a professional body such as the NMC could be so utterly incompetent as it has made itself appear to be? Could it possibly have been to take the complaint beyond the three-year cut-off point for legal action to proceed? They need not have been concerned.The fact is that this dear lady's life was not worth a jot in any case.

When it became clear that we could not obtain justice through the complaints process, we actually approached a number of solicitors. We were told, quite plainly and simply, that it was all about money. Loss of future earnings was zilch and mum had no dependents. The three days of suffering at the hands of the registrants at Caterham Dene was but a trifle and all she was worth was the cost of her funeral expenses. The case was just not financially viable enough to proceed with. It was a cruel honesty for which the solicitor apologised. Well, she was honest with us, at least.

In context with our reference to Shipman above, the solicitor confided to us during the telephone interview that our experience is not uncommon in the NHS and a culture has developed of nurses taking it upon themselves to determine quality of life and putting people down like pets at a veterinary surgery! She made these comments in response to my account of what occurred at Caterham Dene.

We placed this case before the NMC to obtain justice for my mother. We were assured that, through the offices of the NMC, we could obtain something approaching the reprimand at very least that we expected for these miscreants. Recommending 'learnings' was an insult to hermemory! This dear lady perished in a place which, in her own last words to me before they turned her into a virtual vegetable, she found objectionable. She actually said she ‘didn’t like them in there’. The Trust played us a merry dance for long enough and the NMC did the same. Is the NMC just another beast without any teeth?

We are not empowered to undertake a general investigation into the performance or conduct of unnamed individuals at a particular institution or organisation where it is said that there have been general failings on the part of that institution or organisation or its staff in general.

In other words, the registrants at Caterham Dene were following policy and could not, therefore, be held personally responsible. They had followed procedure!

Nevertheless, the NMC forced three innocent nurses to suffer such scrutiny by the IC and pursued the case over the Christmas period – the worst of all possible times for them – for anyone! Those rascals at CaterhamDeneHospital in the meantime were permitted to escape into the woodwork because, as we now understand, they had adhered to the hospital procedure and the protocols of the Liverpool Care Pathway.

Further correspondence followed:

Euphemism will not conceal the plain and simple truth that it is the intention of the Liverpool Care Pathway, by omission and by commission, to take a life.

Take note, therefore: The NMC is here advising all those who feel their friend or kin were placed on the LCP wrongfully and did, thereby, have their lives taken should contact the police!

Dear Ms. Whitfield,

With respect, you cannot appreciate or understand the extent to which my mother’s untimely death still affects this family. It is now almost four years since this lady was taken from us and the more we have discovered through this time has served only the more to distress us further, that these are the awful times in which we live and that the nursing profession has sunk to such a dismal level. The disgraceful things we read almost on a daily basis in the newspapers serve only to confirm what we have discovered for ourselves. And the NMC, which should be gainfully employed in pursuing a gold standard of conduct in the nursing profession, averts its gaze and does nothing.

This lady, my mother, a grandmother and friend, a lady who had attained the age of respect - a respect which she did not receive at Caterham Dene Hospital – suffered indignity to her person and damage to her property, a hearing aid, without which she could not possibly have knowingly communicated any such consent as your registrants claim to have done, to being dosed with the morphine which reduced her to the condition in which I found her, that of a virtual vegetable. Her last words to me in this world haunt me to this day, that she didn’t like them in there! How in heaven’s name can DickonWeir-Hughes step in, remove this case from the scrutiny of the IC and deny that there is any case to answer? How may he? How dare he!It doesn’t make sense. An explanation really is warranted!

The NMC forced three innocent nurses to suffer such scrutiny by the IC over the Christmas period – the worst of all possible times – and these rascals at CaterhamDeneHospital are permitted to escape into the woodwork. The only sense that we can make of this is in the context of a statement made to us by Mr. Peter Pinto de Sa:

We are not empowered to undertake a general investigation into the performance or conduct of unnamed individuals at a particular institution or organisation where it is said that there have been general failings on the part of that institution or organisation or its staff in general.

Are all these reported failings at CaterhamDeneHospital, such as permitting mum to present cyanosed and doing nothing, only apparent failings and actually a result of adherence to and pursuance of the Liverpool Care Pathway? You state that there is nothing more to be said but explanation really is required! It does not make sense. You state that you do not consider that any new material has been supplied. Perhaps, from the standpoint of the NMC that is so but, from our standpoint, that is certainly not the case.

In previous correspondence with the PCT, the HC, the PHSO, and the NMC, we have continued to state our belief that there is no other explanation for my mother's sudden and rapid decline and demise at the hands of persons unknown at Caterham Dene than that this was by a tacit policy to 'let them go' and to actually 'help them on their way.' We have supplied good reasons to support this belief. We have expressed this belief since July 2007, right up unto the present time. This belief has never been denied; rather, it has just been passed over without comment or mention. Only now have we discovered, and to our utter dismay, that the flawed Liverpool Care Pathway was and is in use at CaterhamDeneHospital.

It has taken almost four years to confirm our belief to be true and that is an utter disgrace. What is distressing and worrying is that no-one - until now - thought to speak up and comment upon the incidents we have reported to have occurred, to recognise in them the implementation of the Pathway, and to assure us that this was not at all some tacit policy as we had suggested but a perfectly open and above-board set of procedures and guidelines being rolled out across the NHS. It does not make sense.

So, why the reticence? Is the belief of Dr. Peter Hargreaves, Consultant in Palliative Medicine, and others that this protocol is both flawed and dangerous more widely held? Are there many more that do hold this belief but prefer, for professional reasons, to remain silent? It does not make sense.

In previous correspondence with the PCT, the HC, the PHSO, and the NMC, we have continued to assert that mum was robbed of her life, that her life was taken. This assertion has never been denied; rather, it has just been passed over without comment or mention. Only now is it suggested that this actually be referred to the police! This is only what does occur under the Liverpool Care Pathway, after all: lives are taken. Should this protocol actually be a matter for police referral, then?

It is these circumstances of our loss that move us to pursue this cause with such vigour, as you may surely understand from our accounts of the matter related to you in the ‘copious’ correspondence! Indeed, it is not for ourselves and our loss that we fight on but for my mother and because of the circumstances of her death – the manner in which she was actually robbed of her life! We may not come to terms with our loss whilst this injustice continues.

In pursuit of this cause over the past almost four years, we have been ignored, lied to, and our petitions have actually been returned ‘refused’ by Royal Mail! The HC report readily owns up to actual falsification of the documented record and provides a litany of failures. Are these all to be excused as no matter worthy of mention? Why, yes, for you are not, in the words of Mr. Peter Pinto de Sa, ‘empowered to undertake a general investigation into the performance or conduct of unnamed individuals at a particular institution or organisation where it is said that there have been general failings on the part of that institution or organisation or its staff in general.’

You end your letter with the bitter and sarcastic note that you would normally provide details of further organisations to which we could refer our concerns. Does the NMC and do those that hold office under its aegis know no end of shame and, in this case, ignorance? Given Mr. Peter Pinto de Sa’s statement in the regard of ‘general failings on the part of that institution or organisation or its staff in general,’ we might pursue this matter further with the Care Quality Commission.

Will the NMC, if it will do nothing more, not add its voice to that Dr. Peter Hargreaves and others and raise a hue and cry to get this Care Pathway rolled back and removed? The Liverpool Care Pathway was a tool designed to be used with patients already diagnosed to be terminally ill; it was never a diagnostic tool per se to determine a terminal condition. It was designed at the Marie Curie Hospice in Liverpool specifically for the terminally diagnosed patient and to recognise when a point had been reached that death was near or imminent so as to provide as peaceful and gentle path from this world as might be provided. These patients were already diagnosed to be dying from cancer; the Pathway was not the tool used to make that diagnosis, but a means - a 'pathway' to follow - to determine that point.

Clearly, anyone who falls into the clutches of the proponents of LCP and ticks all the boxes will be given assisted passage into the next world care of the NHS. This will apply particularly to the elderly who are, in any case, already suffering from that most terminal of all conditions - Old-Age! This will apply even contrary to the expressed wishes of patient and family, as this family has discovered at Caterham Dene. This also explains the belligerence of the nurse at our protests, that it was I who was being 'uncaring' not she. Of course! Now, her attitude makes sense.

A culture of death is pervading the NHS. A dark shadow is stalking our hospitals and care homes. The right to death is becoming paramount over the right to life. The LCP is providing a newfound legitimacy and cover to an unspoken policy that has, actually, been in place for decades!

About Me

I am distraught and I despair that these events have befallen this family. The picture is of me and my lovely mum, murdered on the NHS (National-socialist Health Service). Murdered. Is that too strong a word? Her life was taken without her permission. By omission and by commission, actions taken and not taken conspired to end her life. She was kept in ignorance of what was proceeding before her very eyes, as were we. Was she, then, not murdered?